Urinary tract infections (UTIs)

What is a UTI?

A urinary tract infection (UTI) is a common infection that can affect your:

• bladder (cystitis)
• urethra (urethritis)
• kidneys (pyelonephritis).

The most common type of UTI in women is an infection of the bladder (cystitis).

Symptoms

UTI symptoms may include:

• a burning sensation when doing a wee
• pain in your lower belly when doing a wee
• pain in your lower back
• weeing more often than usual
• weeing before you can get to the toilet (leaking or incontinence)
• feeling like you need to wee but not being able to
• feeling like your bladder has not fully emptied after doing a wee
• wee that is smelly, bloody, cloudy or darker than normal
• having a fever
• confusion, nausea or vomiting.

See your doctor straight away if you have a fever and pain in your back (kidney area) as it may be a kidney infection.

Causes

UTIs are caused by germs (bacteria) entering the urinary system, usually via the tube that carries wee out of the body (urethra).

This can be due to:

• bacteria going from your anus into your urethra
• bacteria going into your urethra after sexual activity
• your bladder not emptying properly and leftover wee causing infection.

Who is at risk?

Some women have a higher risk of getting a UTI. For example, women who:

• are sexually active
• are approaching menopause
• have diabetes
• have urinary incontinence
• have poo (faecal) incontinence
• have had recent pelvic or vaginal surgery.

A partner is not at risk of catching a UTI if you have sex. But your symptoms may make it uncomfortable to have sex.

Diagnosis

A UTI is usually diagnosed with a urine test. Your doctor will do a test during your appointment and send your urine sample to a laboratory to confirm the infection. Your doctor may also ask to do a physical examination.

Management and treatment

There are a few things you can do to treat a UTI. For example:

• keep your body well hydrated by drinking six to eight glasses of water per day
• add urine alkalisers (e.g. Ural) to your water to reduce the burning and discomfort
• take the full course of antibiotics (prescribed by your doctor) to clear up the infection.

Symptoms should go away within a few days of taking antibiotics.

It’s important to see your doctor if you have symptoms. If left untreated, UTIs can develop into serious kidney infections.

If you are pregnant and you think you have a UTI, see your doctor straight away.

Recurrent UTIs

About one in five women will get recurrent UTIs. Recurrent means two or more infections in six months, or three or more infections in a year.

This can happen if your body doesn’t respond to antibiotics. In these cases, reinfection usually happens within the first two weeks of treatment.

Risk factors for recurrent UTIs include:

• a history of childhood urinary conditions and surgeries
• a history of UTIs, including childhood UTIs
• having a mother with a history of UTIs
• sexual activity and new sexual partners
• using spermicides, vaginal diaphragms and douching.

Recurrent UTIs may also happen due to:

• pregnancy
• menopause
• blockage of the urinary tract
• your bladder not fully emptying
• kidney stones
• diabetes that is not well managed
• poo (faecal) incontinence.

If you have recurrent UTIs, it’s important to find the cause. This may involve:

• a physical examination to look for abnormalities
• a urine test
• an ultrasound of the urinary tract, or in some cases a CT scan of the kidneys, to check for abnormalities
• a cystoscopy to see inside your bladder.

Persistent (chronic) UTIs

A persistent UTI is when an initial infection, or series of infections, doesn’t fully go away. Persistent UTIs can ‘flare’ and may feel like separate infections. They can be harder to diagnose, as urine tests tend to come back as ‘negative’.

Persistent UTIs can be very painful and severely impact your quality of life. They are often associated with other chronic pain syndromes such as persistent pelvic pain.

Preventing UTIs

You can try different things to prevent UTIs. For example:

• keep your body well hydrated by drinking six to eight glasses of water per day
• avoid holding on to your wee for too long
• relax when you go to the toilet and allow time to fully empty your bladder
• wipe from front to back after going to the toilet to avoid transfer of bacteria from your anus to your urethra
• go to the toilet straight after sex to reduce the risk of bacteria going into your urethra
• avoid constipation, as this can prevent your bladder from emptying properly.

After menopause, you can try vaginal oestrogen cream, pessaries or tablets to improve vaginal flora and restore PH levels, which may help to prevent UTIs.

Note that you should not use douches or vaginal deodorants, as they can cause irritation and an unhealthy bacterial imbalance in your vagina.

Your doctor may recommend other treatments, such as long-term antibiotics.